Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23615.1437 | WY |
NPI | 1003286956 |
---|---|
Provider Name | Dr. Anne-Marie T Octavio |
First Address | Sheridan, WY 82801-8320 |
Second Address | Sheridan, WY 82801-8320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 17/08/2016 |